RN Case Manager – Pre-Access (Per Diem)
Valley Presbyterian Hospital
Ensure the Right Care, at the Right Time, in the Right Setting
At Valley Presbyterian Hospital, our Case Management team plays a critical role in supporting patient access, regulatory compliance, and efficient care delivery. We are seeking an experienced RN Case Manager – Pre-Access to coordinate admission reviews, facilitate patient transfers, and ensure appropriate patient status determinations based on medical necessity guidelines. This role serves as a key liaison between physicians, nursing, admitting, financial services, and external healthcare organizations to support seamless patient access and optimal utilization of hospital resources.
What You'll Do
- Review all acute care admissions to ensure appropriate patient status and level of care using established medical necessity criteria
- Conduct admission reviews utilizing InterQual and other proprietary utilization review tools
- Document admission determinations within the electronic medical record and utilization management systems
- Collaborate with admitting physicians, Emergency Department providers, and hospital leadership to determine the most appropriate level of care
- Coordinate patient transfers into the hospital, including obtaining clinical information and transfer agreements
- Serve as a liaison between physician offices, admitting, nursing, business office, and ancillary departments to facilitate efficient admissions
- Initiate physician advisor referrals when admission status or level-of-care determinations require additional review
- Monitor observation patients and ensure appropriate status changes and documentation
- Collaborate with Emergency Department leadership to improve patient throughput and bed utilization
- Partner with Operations Supervisors regarding bed placement, patient flow, and special admission needs
- Communicate payer requirements, utilization concerns, and reimbursement-related issues to physicians and care teams
- Participate in departmental meetings, bed board huddles, and performance improvement initiatives
What You Bring
- Strong clinical assessment and critical thinking skills
- Expertise in utilization review, admission status determination, and medical necessity criteria
- Knowledge of InterQual, CERME, Medicare, Medi-Cal, managed care, and third-party payer requirements
- Understanding of EMTALA and other federal and state healthcare regulations
- Ability to exercise independent judgment and make sound clinical decisions
- Excellent communication and relationship-building skills
- Strong organizational skills with the ability to manage multiple priorities in a fast-paced environment
- Ability to work collaboratively with physicians, nursing, case management, and operational teams
Experience
- Minimum two (2) years of direct acute care nursing experience required
- Critical Care experience preferred
- Previous Case Management, Utilization Management, or Discharge Planning experience preferred
Education
- Bachelor of Science in Nursing (BSN) required
Requirements
- Current California Registered Nurse (RN) license
- Management of Assaultive Behavior (CPI or equivalent) certification within 30 days of hire
- LA City Fire Card certification within 30 days of hire
Why Join Valley Presbyterian Hospital?
At Valley Presbyterian Hospital, you'll join a team where people feel connected to a meaningful mission, supported by their colleagues, and empowered to make a difference. Employees consistently report strong teamwork, a sense of belonging, and pride in serving our community. Our culture emphasizes respect, collaboration, inclusion, and compassionate care, creating an environment where people can grow professionally while making a lasting impact.
Apply today and help ensure patients receive the appropriate care at the appropriate level while supporting operational excellence at Valley Presbyterian Hospital.